The objective of this project is to determine whether continuing medical education effects changes in physicians' knowledge and/or behavior. We propose to systematically evaluate the effectiveness of four strategies for delivering continuing education to primary care physicians using the topic of acute myocardial infarction as a model. The educational content has been carefully developed to reflect discrete objectives and will be presented in four phases: 1) Phase A: as part of a university-based multi-topic refresher course; 2) Phase B: as part of a university-based cardiology course; 3) Phase C: as part of a community-based cardiology program for physician colleagues; 4) Phase D: as part of a community-based cardiology program for members of the health care team responsible for cardiac patients in that community. The four-phase repetition of the program permits a comparative investigation of the following variables: 1) general versus specific educational context; 2) remote-site versus community-based educational site; and 3) physician only versus cardiac health care team educational audience. The program will be replicated within each phase to permit between and within-group comparisons. Data about the following outcomes will be collected during each phase of the study: 1) Knowledge attained by program participants; 2) knowledge retained over a six-month period of time by program participants; and 3) appropriate changes in management procedures of hospitalized patients with suspected or proven acute myocardial infarction. The first two outcomes will be measured using content-parallel forms of a multiple-choice test of knowledge; the third outcome will be assessed by an audit of patient records.